Claims Specialist

Health Care Service Corporation

. Process and examine medical, disability, and/or life insurance claims .

Posted 10/15/2026full-timeRemote • United StatesMid-LevelSenior💰 $42,200 - $79,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates extensive experience in medical claims processing, with a strong understanding of fraud detection, PPO reimbursement methodologies, and the ability to maintain detailed records. Excels in a fast-paced, customer-service-driven environment while effectively collaborating with team members and stakeholders.

Highest-signal resume keywords

Medical Claims Processing ExperiencePPO Reimbursement MethodologiesFraud Detection and Abuse PatternsStrong Organization and Attention to DetailEffective Communication Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Medical Claims ProcessingCode Review EditsClaims ExaminingAnalytical SkillsDecision-Making SkillsMathematical SkillsDocumentation SkillsProblem-Solving SkillsTime Management SkillsAdaptability to New Systems

Soft Skills

Interpersonal SkillsCreative Problem-SolvingConflict Resolution SkillsTeam CollaborationAbility to Work Under Pressure

Tools & Technologies

Microsoft OfficeWordExcelOutlookAccess

Industry Keywords

Medical TerminologyDisability ClaimsLife Insurance ClaimsClaims Processing KnowledgeStop Loss Coverage

About the role

Key responsibilities & impact

Process and examine medical, disability, and/or life insurance claims
Apply specialized claims-processing knowledge and code-review edits
Identify fraud and abuse patterns
Apply PPO reimbursement methodologies and understand stop loss coverage
Investigate claims and make informed decisions
Maintain accurate, detailed records and thoroughly document claim information
Organize workflow, prioritize numerous tasks, and follow up on responsibilities
Support other team members and collaborate with employees, providers, clients, and other departments
Meet prescribed deadlines and work effectively in a fast-paced, customer-service-driven environment
Adapt to new systems, policies, environments, and process-improvement methodologies

Requirements

What you’ll need

4 years medical claims processing experience
Comprehensive knowledge of specialized medical claims processing
Understanding of code review edits, fraud and abuse patterns, PPO reimbursement methodologies, and stop loss coverage
Excellent verbal and written communication skills
Excellent interpersonal skills
Performance and audit scores of 99% payment, 97% financial, and 97% accuracy or better
Microsoft Office proficiency
Strong organization and attention to detail
Ability to work effectively with team members, employees, providers, and clients
Ability to work in a fast-paced, customer service-driven environment
Strong disability and/or life claim knowledge
Understanding of all aspects of claims examining
Solid investigation, analytical, organizational, math, and decision-making skills
Minimum 5 years insurance claim experience with understanding of medical terminology
Ability to maintain accurate, detailed records and thoroughly document claim information
Creative problem-solving and conflict-resolution skills
Ability to organize workflow and accept additional tasks and projects
Strong time management skills
Self-starter able to prioritize, manage, and follow up on numerous tasks
Ability to make decisions independently or with minimal supervision
Ability to handle pressure, interact effectively with other departments, and meet deadlines
Ability to foster a positive team environment
Adaptability to new systems, policies, environments, and improvement methodologies
Effective use of personal computers and related software
Proficiency in Word, Excel, and Outlook; Access preferred
Preferred employment with HB as a Medical Claims Analyst and then Sr. Claims Analyst
Four-year college degree in medical and/or business field preferred/a plus

Benefits

Comp & perks

Health and wellness benefits
401(k) savings plan
Pension plan
Paid time off
Paid parental leave
Disability insurance
Supplemental life insurance
Employee assistance program
Paid holidays
Tuition reimbursement
Other incentives
Annual incentive bonus plan subject to the terms and conditions of the plan